We require supporting documentation that outlines the specific SEP and whether the Member qualifies. The required information may vary depending on the nature of the event.
If you are unsure what supporting documents you need to provide, please contact our Member Services Department for assistance at (855) 624-6463, select option 1, then choose option 5.
1099 Forms are mailed to brokers prior to the end of January each year.
To be eligible as an Employer Group, there must be at least one eligible common law employee who is receiving a W-2, who is not an owner or spouse of an owner, and is working a minimum of 30 hours per week. Sole Proprietors and groups composed only of an owner and spouse are not eligible for a group plan and must enroll on the Individual Market. An eligible group must be headquartered in Maine. It cannot have more employees in any other state than are employed in Maine to be eligible for coverage with Community Health Options.
Group size is determined by number of Full Time Equivalents (FTEs). An employer with 1 to 49 Full Time Equivalents is considered a Small Group and will be community rated. Any Employer Group with 50 or more Full Time Equivalents during the prior calendar year is considered a Large Group, will receive premium rates based on the group’s claim experience, and will be medically underwritten. Groups with 50 or more FTEs are also considered an Applicable Large Employer (ALE) by the IRS and are subject to specific reporting requirements. Visit the IRS website for more information about ALE reporting requirements.
To calculate the number of Full Time Equivalents (FTEs), you need to also consider your part-time employees. Part-time employees are those who work less than 30 hours per week. Add up the average number of hours worked per week of all part-time employees for the previous calendar year and divide by 30. Take the result and add the average number of full-time employees (30 or more hours per week) that you had on payroll during the prior calendar year. This is your number of Full Time Equivalents. If you need assistance with the calculation, please email businessdevelopmentinfo@healthoptions.org or call (207) 402-3353 to request an FTE calculator tool.
The number and variability of plans you may select for employees to choose from are limited by the number of enrolled employees.
For commissions to be paid to a new broker who is taking over an existing enrolled employer, the broker must obtain a signed Broker of Record Letter from the employer group. Submit the letter directly to your Account Manager in our Business Development Department to have the change processed.
Commissions are paid to appointed brokers no later than the end of the month for any commissions earned for the prior month.
Please email BusinessDevelopmentInfo@healthoptions.org, or call 207-402-3353.
Please contact our Business Development Department directly at 207-402-3353 or email BusinessDevelopmentInfo@healthoptions.org.
If you need assistance with an Individual Member, please contact Member Services at 1 (855) 624-6463 then select option 1, then select option 5. For assistance with a Group client, please contact your Account Team in our Business Development Department at (207) 402-3353.
Please contact any Account Team member in the Business Development Department at 207-402-3353.
You may be able to get insurance if you have recently lost health coverage through a school-sponsored plan or as you turned 26.
A resource for individuals and families to learn more about our plans.
We have partnered with Rx Savings Solutions to help save you money on your medications. Find out more about the program in this guide.
Health Options Online is Health Options' new behavioral health telemedicine program. Find out more information about the program in this guide.
General information about your plan, including where to go for your healthcare.
A guide to our Chronic Illness Support Program and its benefits.
Filling prescriptions made easy with information on our prescription drug benefits that fit your needs.
Health Options firmly believes in treating the whole person- that includes physical health, mental health, and substance use disorder services.
Information about our wellness program, to help in achieving better health overall.
We support your success by making it easier for you to present the best products and services available. Save this digital document to quickly access basic tools to share with your clients. They will surely appreciate the local option.
Coinsurance is a percentage (for example 30%) you pay toward the cost of certain Covered Services. The plan will pay the remaining amount. Unless specified on your Schedule of Benefits, coinsurance begins once you have met your deductible.
A copayment is a fixed amount (for example, $15) you pay for a covered healthcare service, usually at the time you receive the service. Unless specified on your Schedule of Benefits, the deductible does not have to be met for the application of a copayment. The amount can vary by the type of covered healthcare service. Copayments do not count toward your deductible. Copayments do count toward your out-of-pocket maximum.
Covered services are the goods or services that the plan will help you pay as outlined in the Member materials. Your Member materials include the Member Benefit Agreement, Schedule of Benefits, and Summary of Benefits and Coverage.
The deductible is the amount you pay for certain covered services before the plan pays benefits. If your plan covers more than one person, there will be both an individual deductible and a family deductible. Any one Member covered under your policy only needs to meet the individual deductible, while the other Members of your family combine to meet the remainder of the family deductible.
Out-of-pocket costs are the costs you pay. Maximum out-of-pocket costs are the total of your copays, coinsurance, and deductible payments that you will be expected to pay.
We cover prescription medicines that are proven effective and list these drugs on a “formulary.” Go to HealthOptions.org/Formulary to see our complete formulary.
Your Primary Care provider (or PCP) is a family doctor, nurse practitioner, pediatrician or other provider with whom you maintain a long-term relationship. Your PCP is a partner in your healthcare who will advise you and provide treatment on a range of health-related issues. He or she may assist you in your interactions with specialists.
This Community Health Options Webinar covers any questions you may have about healthcare open enrollment for 2019!
Entering video widget Out of video widgetThis Community Health Options Webinar covers any questions you may have about healthcare open enrollment for 2019!
Out of video widgetWith substance use rising across the nation and state of Maine, how should employers implement testing programs and cultures of clean workplaces?
Out of video widgetThis Community Health Options Webinar covers any questions you may have about healthcare open enrollment for 2019!
With substance use rising across the nation and state of Maine, how should employers implement testing programs and cultures of clean workplaces?